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Department of Pediatric Oncology

Ako Hosono, Hiroshi Kawamoto, Naoko Yasui

Introduction

The Department of Pediatric Oncology was established in December 2011 to provide treatment for pediatric cancers including a wide variety of diseases such as hematologic malignancies comprising leukemia and lymphoma, embryonal tumors comprising neuroblastomas, nephroblastomas and hepatoblastomas, and mesenchymal tumors comprising Ewing sarcomas, rhabdomyosarcomas and osteosarcomas. Although they usually occur in children under the age of 15, they occasionally occur in adolescents and young adults (AYA). Most of the pediatric cancers are highly chemosensitive as well as radiosensitive. They are possibly curable in a certain situation where the intensity of multidisciplinary treatment and disease characteristics are balanced well. However, there are absolute refractory cases who need new treatments other than standard chemotherapy. Moreover, long-term survivors of pediatric cancers often suffer from complications secondary to chemotherapy and radiotherapy. The three major objectives of the Department of Pediatric Oncology in the NCCE are as follows: (1) To provide state-of-the-art treatment for AYA patients in collaboration with the Medical Oncology group. (2) To develop new treatments for pediatric cancer by sharing agents and knowledge with the Clinical Development Center. And (3) to provide less toxic proton-beam radiation therapy as one of the three proton centers for children in Japan. All three activities are currently on-going and several projects have already started (refer to “Research activities and clinical trials”).

Routine activities

The pediatric outpatients service is open for three days a week, Monday, Wednesday and Friday, to treat newly diagnosed patients, patients who received chemotherapy in the outpatient setting and to provide follow-up treatment to patients who have completed an intensive treatment course. Also, the care of children receiving palliative treatment is carried out with the Palliative Care and Psycho-Oncology Group. Daily rounds and a conference are held every morning. We also attend conferences with the Medical Oncology, Orthopedic Surgery, Thoracic Surgery and Urology Department s at any time.

Research activities and clinical trials

As written above, several projects that are expected to achieve our objectives are ongoing. Proton-beam radiation therapy is currently provided as an Investigational Medical Care (Sensin-iryo). However, the medical costs related to the treatment with this system could possibly financially overburden patients and their families. To pursue the possibility of getting this technique approved under the Japanese Health Insurance system, we plan a clinical trial to gather data on safety for pediatric patients. Other projects include treatment development using relatively new off-label drugs as well as experimental agents such as peptide vaccines. One of the objectives of the following trials is gathering data on, and assessing the safety and efficacy data of, such off-label drugs and eventually getting them approved by the Ministry of Health, Labour and Welfare.

One clinical trial described below are currently active.

A phase I trial of immunotherapy using HLA-A2 and A24-restricted glypican-3 peptide vaccine for pediatric tumors.


Table 1. Number of patients